NEW YORK (Reuters Health) - People who felt extremely
stressed directly after the terrorist attacks of September 11,
2001 were at increased risk of being diagnosed with
cardiovascular problems in the following 3 years-even if they
only saw the attacks on TV, a new study shows.

The risk was particularly strong for those who continued
worrying about terrorism for years afterwards.

"The bottom line is the vast majority of our sample had no
direct exposure, and yet their acute stress reactions are
associated with subsequent heart problems," Dr. E. Alison
Holman of the University of California, Irvine, one of the
study's authors, told Reuters Health.

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"We need to think about how we communicate risk to people.
We had lots and lots of terror alerts following 9/11...none of
which actually panned out. Those kinds of terror alerts could
potentially be increasing people's stress or encouraging people
to worry more."

Holman and her team followed a nationwide sample of 2,592
people for 3 years after the attacks. All had completed a
survey of their mental and physical health before September 11,
2001.

Only 3.6 percent were directly exposed to the terrorist
attacks, for example, being an eye witness or having a loved
one in the Pentagon or the World Trade Center at the time of
the attack. Another 63.2 percent watched the events live on TV
and 33.2 percent had not seen any live coverage.

The researchers defined acute stress as having a high level
of post-traumatic stress disorder (PTSD)-type symptoms within
several days of the attacks, such as restlessness, feeling on
edge, difficulty sleeping or intrusive thoughts of the attacks.
Based on this definition, 10.7 percent of the study
participants had an acute stress response.

Even after the researchers allowed for the study
participants' mental and cardiovascular health before the
attacks, people who reported acute stress responses were 53
percent more likely to be diagnosed with a heart attack,
stroke, high blood pressure or other heart-related ailment in
the following three years.

People who continued to worry about the attacks and also
experienced acute stress responses were nearly five times as
likely to be diagnosed with heart problems 2 years after
September 11, 2001, and had three times the risk of such a
diagnosis 3 years later.

The findings show that front-line health care providers
must take patients' reports of stress seriously, because stress
can have important health consequences, Holman noted. "Maybe
some kind of intervention is called for in the immediate
aftermath of a traumatic event," she added, such as biofeedback
or other stress relief techniques.

Americans have much less exposure to terrorism than people
living in many other parts of the world, where violence occurs
on a daily basis, the researcher pointed out. "If people who
are indirectly exposed are having problems, one can only
imagine what's going on for the population of other parts of
the world," she said.